Streptococcus gallolyticus pasteurianus, Penicillin-Sensitive Bacteremia, Which Developed During Concommtent Amoxicillin Treatment and After an ENEMA

Abstract

Streptococcus gallolyticus pasteurianus (SGP) is normal flora in the human bowel but is seldom a pathogen in the setting of immunocompetency. A 14-month-old healthy child instrumented with a ventriculoperitoneal shunt developed acute otitis media and had a tap water enema administered for constipation. By report, fevers persisted and clinical signs of meningitis and peritonitis appeared. After 9 days of high-dose amoxicillin therapy, increased fever prompted a blood culture, which grew penicillin-susceptible SGP. Aseptic meningitis was discovered on lumbar puncture. The ventriculoperitoneal shunt was removed and was sterile for bacterial growth. Irritability and fever quickly resolved. High-dose amoxicillin treatment was ineffective in prevention of penicillin-sensitive SGP bacteremia and development of presumed SGP meningitis. Enemas in children with constipation may predispose to infectious complications from this gut flora organism from bacterial translocation or from rectal wall perforation.